Evaluation of correct knowledge of key danger signs in pregnancy among antenatal clinic attendees at a tertiary health facility in Nigeria.

CONTEXT: Test of knowledge of pregnant women on key danger signs as a marker to assess the quality of information shared during health education at the antenatal clinic (ANC) is desirable. AIM: The aim was to assess correct knowledge of danger signs among pregnant women who attend ANC. SETTINGS AND DESIGN: A cross-sectional design conducted among pregnant women at the ANC of the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested structured questionnaire that contains sociodemographics, past obstetrics history, and a list of test questions to assess correct knowledge of danger signs was administered to each consenting participant. STATISTICAL ANALYSIS USED: Descriptive and bivariate analyses were performed. The knowledge score of key danger signs in pregnancy (KDSP) was measured on a scale of 0-7 and participants were scored as having poor (0-2), fair (3-4), or good (5-7) knowledge. The reliability of the questionnaire to assess knowledge score was determined with Cronbach's alpha. Statistical significance was set 5%. STATA 12.0 Software was used. RESULTS: The mean age of respondents was 30.28 ± 4.56 with the majority (75.1%) of respondents aged 26-35 years. The Cronbach's alpha was 0.871. In general, the knowledge score was good and the associated factors on bivariate analysis were younger age (P = 0.028), Islamic religion (P = 0.048), ethnicity (P = 0.03), professional occupation (P = 0.01), and previous attendance of health talk on KDSP (P < 0.0001). CONCLUSION: There was a high knowledge score of KDSP, but some still have some misconceptions that need to be addressed.

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria.

CONTEXT: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Vesico-vaginal fistula repair as a day case: is it a worthy venture?

Two vesico-vaginal fistula patients who were successfully managed with outpatient care as an alternative approach, to ensure early access to care and integration into their family. The two patients had simple uncomplicated mid-vagina fistulae surgically repaired with local infiltrative anaesthesia. We suggest some selection criteria and clinical guidelines that can facilitate successful treatment by this choice of care.

Attitude of infertile women to child adoption in Nigeria.

Infertility has serious consequences especially in Africa where a high premium is place on child bearing. An interviewer-administered questionnaire was administered on 396 consenting women seeking infertility treatment at the gynaecological clinic of the University College Hospital, Ibadan in an attempt to assess the attitude of infertile women in Nigeria to child adoption and its acceptability as a management option for infertility. Most (64%) believed its culturally unacceptable and only 17% will try it as an option. Sustained advocacy, community mobilization and enactment of supportive laws were some of the suggestions made by respondents to improve its uptake.

Menstrual characteristics of secondary school girls in Ibadan, Nigeria.

BACKGROUND: Disturbances of menstrual function are the commonest complaints among adolescents. Disorders of menstruation may have implications for future reproductive health. OBJECTIVE: To assess menstrual patterns among school girls in Ibadan, south-western Nigeria. METHODS: This was cross-sectional descriptive study in which 1,213 apparently healthy school girls were selected by multistage sampling technique in fifteen secondary schools from the five local governments within the metropolis. Information about details of menstrual experience was obtained with a self-administered questionnaire. RESULTS: The girls were aged between 9 and 23 years. Majority of respondents 768 (633%) experienced normal cycle length, 391 (32.2%) had short cycles; and 55 (4.5%) had cycle length greater than 35 days. Prevalence of normal cycles increased with increasing age; abnormalities of cycle length tended to decrease with increasing age (p < 0.01). The majority, 1,152 (95%), had normal menstrual loss. The majority 882 (72.7%) experienced dysmenorrhoea; severe dysmenorrhoea was reported by 154 (12.7%). Cycle length was not associated with presence of dysmenorrhoea (p > 0.05); 695 (57.3%) had symptoms of pre-menstrual syndrome. CONCLUSION: Prevalence of menstrual abnormalities among adolescent schoolgirls is high. More attention should be paid to identify and treat these menstrual morbidities.

Determinants of post-caesarean wound infection at the University College Hospital Ibadan Nigeria.

OBJECTIVE: To determine the risk factors that predispose patients to post-caesarean wound infection at a tertiary health institution in developing country. METHOD: It was an observational study of all women that had caesarean (elective and emergency) delivery between July and September, 2004. The outcome of their post-caesarean wound was assessed. Statistical analysis (Bivariate and logistic regression) of the identified risk factors in patients who developed wound infection was performed at a 95% level of confidence. RESULTS: The post-caesarean wound infection rate was 16.2%. The identified risk factors were lower educational status, multiple pelvic examination, offensive liquor at surgery and patients that are unbooked. Following logistic regression, women with up to primary school were 20 times more likely than those with secondary education and above to develop wound infection (95% CI OR = 1.8 to 250.0). CONCLUSION: The outcome showed that the identified determinants of post-caesarean wound infection were comparable with earlier reports. Women with lower educational status are more at risk in this study. Therefore, these women need special attention to reduce the risk.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria.

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15 +/- 2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p = 0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks.

Comparative evaluation of haemoglobin estimation amongst pregnant women in Ibadan: Hemocue - B haemoglobin analyzer versus haemiglobincyanide (standard) method as the gold standard.

This was a comparative crossectional study that was conducted among 557 antenatal women at the University College Hospital, Ibadan, Nigeria between 1st April and 30th May 2006. The study compared the accuracy of haemoglobin estimation using an automated HemoCue B analyzer kit with a standard laboratory method (haemogloincyanide) as the gold standard. The result showed a positive correlation of HaemoCue haemoglobin results when compared with the standard methods (Pearson's correlation coefficient = 0.892; p value = 0.000). We concluded that the use of the automated HemoCue kit for haemoglobin estimation gives an objective assessment which overcomes the challenge of extra skilled manpower or power outages in rural areas thereby enhancing access to quality of care in resource poor countries.

Uncomplicated midvaginal vesico-vaginal fistula repair in ibadan: a comparison of the abdominal and vaginal routes.

BACKGROUND: Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula determines the outcome of care. OBJECTIVE: To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair. MATERIALS AND METHOD: This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from January, 2000 till December, 2006. RESULT: Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group (p=0.999). The duration of hospital stay did not differ significantly between the groups (p=0.972). Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group (p<0.001). The complications were failed repair (20.7%) and urinary tract infection (20.7%). The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group (p=0.303). CONCLUSION: Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with lesser blood loss and lower risk of post-operative complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contrary.

Attitude and preferences of nigerian antenatal women to social support during labour.

SummaryThis was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80.2%), spiritual (17.9%), errands (8.6%) and physical activity (6.8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3.57, 95% CI 1.49-8.52), professionals (OR 3.11, 95% CI 1.22-7.94) and women of other ethnic groups besides Yoruba (OR 2.90, 95% CI 1.02-8.26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2.96, 95% CI 1.08-8.11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newborn.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks. (Afr J Reprod Health 2008; 12[2]:89-97)

Comparative evaluation of haemoglobin estimation amongst pregnant women in Ibadan: Hemocue ­ B Haemoglobin analyzer versus haemiglobincyanide (Standard) method as the gold standard

This was a comparative crossectional study that was conducted among 557 antenatal women at the University College Hospital, Ibadan, Nigeria between 1st April and 30th May 2006. The study compared the accuracy of haemoglobin estimation using an automated HemoCue B analyzer kit with a standard laboratory method(haemogloincyanide) as the gold standard. The result showed a positive correlation of HaemoCue haemoglobin results when compared with the standard methods (Pearson's correlation coefficient = 0.892; p value = 0.000). We concluded that the use of the automated HemoCue kit for haemoglobin estimation gives an objective assessment which overcomes the challenge of extra skilled manpower or power outages in rural areas thereby enhancing access to quality of care in resource poor countries. (Afr J Reprod Health 2008; 12[2]:153-159)

The influence of social support on the duration of breast-feeding among antenatal patients in Ibadan.

In Nigeria, breast-feeding has been shown to be very closely related to infant survival. Prolonged and adequate breast-feeding is critical to most infants' nutritional health and growth. This study aims to determine the influence of family support on the duration of exclusive and total breast-feeding of infants of antenatal patients. This cross-sectional study was conducted between 1 September and 30 December 2005. The tool was a structured questionnaire. The main outcome variables were the duration of breast-feeding; both total and exclusive explanatory variables were mainly related to support obtained during breast-feeding from husband and older female relations. Husbands support significantly increased the total duration of breast-feeding by a mean of 1.69 months (95% CI 0.88, 2.51), however, exclusive breast-feeding was not significantly affected by the husband's support (OR 0.94; 95% CI 0.63, 1.39). Female support had a significant influence on both the total duration of breast-feeding which is increased by a mean of 1.08 months (95% CI 0.14, 2.02), and the adequate conduct of exclusive breast-feeding (OR 1.83; 95% CI 1.17, 2.86). The cultural practice of having additional female support in the postpartum period has been shown by this study to be beneficial. Therefore, this cultural practice should be encouraged and catalogued as a beneficial cultural practice. This practice is also cheap and sustainable.

One-stage repair for combined fistulas: myth or reality?

OBJECTIVE: The repair of combined vesico-vaginal fistulas (VVFs) and recto-vaginal fistulas (RVFs) is challenging to both surgeon and patient. The multistage approach involves at least 3 surgical sessions, all associated with morbidity and sometimes with a colostomy procedure as well. The outcomes of the 1-stage approach were examined. METHODS: Twenty patients aged between 16 and 38 years were recruited for a multicenter study conducted from March 2005 to August 2006. Prolonged obstructed labor was the cause of all fistulas. The VVFs were mainly midvaginal (60%), juxtaurethral (25%), and juxtacervical (15%). The RVFs measured between 1 and 3 cm, they were low in 70% of cases, and 1 was associated with fourth-degree perineal tear. Bowel preparation was performed in all patients prior to surgery. No patient underwent temporary colostomy. RESULTS: Both VVFs and VVFs were successfully closed in all patients, as evidenced by the continence dye test. CONCLUSION: The combined repair relieves economic constraints and emotional challenges, and it accelerates restoration to health and social reintegration for women affected with both VVFs and RVFs.

A review of postoperative care for obstetric fistulas in Nigeria.

Nigeria harbors an estimated 40% of all the women affected with obstetric fistulas today, and at the current rate of treatment in this country, it would take about 300 years to treat them if no new fistulas occurred. This situation obviously runs contrary to the ideals of the United Nations Millennium Development Goals and needs to be reversed. We reviewed the literature on fistula treatment in Nigeria to identify strategies and practices that, if adopted, would likely accelerate the pace of fistula repair and improve postoperative fistula care in this country. A comprehensive nationwide survey, a stronger political will and commitment of resources, a systematic postoperative care and follow-up, more fistula centers, and more fistula campaigns are necessary. Technically, the involvement of all surgeons trained in fistula repair and an experience-based postoperative management protocol will relieve the disease burden carried by women living with fistulas in Nigeria.

Local anesthesia: an appropriate technology for simple fistula repair.

OBJECTIVES: To assess the efficacy of local infiltrative anesthesia with lidocaine hydrochloride in patients undergoing the surgical repair of a simple vesico-vaginal fistula. METHODS: The study was carried out with 21 patients undergoing the repair of a simple midvaginal vesico-vaginal fistula. The patients' perception of pain was evaluated intraoperatively. RESULTS: Most patients indicated that the anesthetic agent provided adequate analgesia, and all fistulas were repaired successfully without postoperative complications. CONCLUSION: Repairing simple vesico-vaginal fistulas is feasible with a local infiltrative anesthetic.

A review of postoperative care for obstetric fistulas in Nigeria.

Nigeria harbors an estimated 40% of all the women affected with obstetric fistulas today, and at the current rate of treatment in this country, it would take about 300 years to treat them if no new fistulas occurred. This situation obviously runs contrary to the ideals of the United Nations Millennium Development Goals and needs to be reversed. We reviewed the literature on fistula treatment in Nigeria to identify strategies and practices that, if adopted, would likely accelerate the pace of fistula repair and improve postoperative fistula care in this country. A comprehensive nationwide survey, a stronger political will and commitment of resources, a systematic postoperative care and follow-up, more fistula centers, and more fistula campaigns are necessary. Technically, the involvement of all surgeons trained in fistula repair and an experience-based postoperative management protocol will relieve the disease burden carried by women living with fistulas in Nigeria.

Parameters of nutrition in school girls in southwestern Nigeria.

OBJECTIVES: To document trends in parameters of nutrition in south-western Nigerian school girls in comparison with earlier reports and provide baseline data for future comparison. DESIGN: A cross-sectional study. SETTING: Fifteen secondary schools from the five local governments in Ibadan, Oyo State in south-western Nigeria. SUBJECTS: One thousand six hundred and seventy five apparently healthy female students aged between nine and twenty three years. RESULTS: One thousand six hundred and seventy three questionnaires were analysed. The mean age, mean height and mean body weight were 15.45 years +/- 2.06 (SD), 154.98cm +/- 8.4(SD) and 46.09kg +/- 8.8 (SD) respectively. The mean body fat was 11.12kg +/- 4.6 (SD); mean lean body mass (LBM) was 34.96kg +/- 4.6 (SD); mean total body water (TBW) was 25.17L +/- 3.3 (SD) and the mean body index (BMI) was 19.07kg/m2 +/- 2.7 (SD). Girls from upper socio-economic background had significantly higher values of anthropometric measurements and body composition for each age than lower socioeconomic class girls. Compared with their peers from another Nigerian city investigated two decades ago, girls in this study were significantly lighter and shorter. CONCLUSION: The study revealed a decline in nutritional parameters among adolescents. The implications of these findings for the reproductive health of Nigerian women are discussed. Serial studies to monitor trends in adolescents are recommended.

Grandmultiparity--trends and complications: a study in two hospital settings.

Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8.99% (10.90% in 1987 to 3.36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8.59% (12.75% to 6.07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91.6% vs. 94.9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85.8% vs. 69.7%, respectively). In Group B 85.9% had spontaneous vertex delivery as opposed to 66.3% in Group A. Caesarean section was the mode of delivery in 9.0% and 24.2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2.51-3.00 kg in both groups. Macrosomic babies formed 3.7% in Group A and 2.4% in Group B, while low birth weight babies formed 17.7% and 11.7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10.85/100 000 total deliveries in Group A and 35.42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3.4% and 6.1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.